NPIMap

Organization Active NPI

Professional Dental Care of Southern Colorado I PLLC

  • Dental Clinic/Center
  • Portales, NM
National Provider Identifier
1033701313
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PROFESSIONAL DENTAL CARE OF SOUTHERN COLORADO I PLLC
Practice address
123 W 2ND St
Portales, NM 88130-6201
Phone
(575) 268-0007
NPI assigned
Feb 8, 2021
Organization subpart
Yes
Parent organization
SSUN HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cary Lacouture, DDS
Title
Clinical Director
Phone
(303) 521-5701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

123 W 2ND St
Portales, NM 88130-6201

Mailing address

10233 S Parker Rd Ste 107
Parker, CO 80134-9314
Phone (303) 521-5701

Other names 1

  • Thompson Smiles Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peter Thompson DDS2 organizations share this tax ID, including this one
Part of
Ssun Health LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1033701313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10233 S PARKER RD STE 107",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801349314",
            "telephone_number": "303-521-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W 2ND ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881306201",
            "telephone_number": "575-268-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL CARE OF SOUTHERN COLORADO I PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSUN HEALTH, LLC",
        "enumeration_date": "2021-02-08",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "LACOUTURE",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "303-521-5701",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thompson Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portales, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.